The urbanization management of medical insurance in the Beibu Gulf Economic Zone will be implemented on July 1st

Newborns can enjoy benefits within 3 months after enrolling in the insurance

Guangxi News Net -Contemporary Life News reporter Huang Dongmei

Core tips

On June 12, the reporter learned from the Human Resources and Social Security Department of the Autonomous Region that Guangxi issued the "Interim Measures for the Basic Medical Insurance for Urban Residents in the Beibu Gulf Economic Zone" (hereinafter referred to as the "Measures").

Insured scope

Covers 3 types of groups.
Individual payment standard: 70 yuan per person per year

It is understood that the basic medical insurance for urban residents adheres to the principle of starting at a low level.
According to the economic development and the affordability of all aspects, the financing level and guarantee standards are reasonably determined, focusing on the medical needs of major diseases, taking into account the outpatient medical care for minor diseases, and gradually increasing the level of protection.
The "Measures" stipulated the insurance coverage: Nanning, Qinzhou, Beihai, Fangchenggang, and Chongzuo 5 cities.

The basic medical insurance for urban residents shall be coordinated at the municipal level, and when the conditions are ripe, it will be coordinated at the autonomous region level.
The insurance coverage covers 3 types of groups, namely, minor residents (including preschool children, non-school personnel under the age of 18); adult residents (non-employed urban residents who are not covered by the basic medical insurance system for employees) and school students (Students studying full-time in all colleges and universities, secondary vocational technical schools, technical schools, primary and secondary schools, etc.
in Guangxi Beibu Gulf Economic Zone, as well as registered children in kindergarten institutions).

The "Measures" stipulate that the basic medical insurance fund for urban residents shall be raised through a combination of individual payment and government subsidies.
Employers with conditions can provide subsidies to the insurance contributions of employees' family members.

In terms of personal payment standards, urban residents pay basic medical insurance premiums at a standard of 70 yuan per person per year.
In the future, the annual payment standards per person will be increased by 25% of the increase in government subsidies.

The government will provide subsidies for the individuals who need to pay for subsistence allowances, severely disabled people who have lost the ability to work, elderly people over 60 years old and minors from low-income families, and minors.

It should be noted that residents who have already participated in the new rural cooperative medical system will not be included in the coverage of the "Interim Measures for the Basic Medical Insurance for Urban Residents in the Beibu Gulf Economic Zone".

 

Payment method

A lump-sum payment every year, newborns within 3 months of enrollment enjoy benefits

According to the "Measures", school students take schools and kindergartens as the insured units, and the schools and kindergartens are responsible for filling in, reviewing, and summarizing the insurance information declared by their students, and go to their coordinating areas to handle social insurance.

Other urban residents take the community as the insured unit, and the community residents committee to which they belong will review and summarize the information they declare in accordance with the regulations, and then go to the social insurance agency in the coordinating area to go through the insurance payment procedures in a unified way.

Insurance premiums are paid in one lump sum annually, and the basic medical insurance premiums paid are non-refundable.
Urban residents should pay the basic medical insurance premiums for the next year from September 1 to December 25, and enjoy basic medical insurance benefits from January 1 to December 31 of the following year.
If the payment is overdue, the basic medical insurance benefits will be enjoyed from the month when the basic medical insurance premiums of the year are paid in full.

First-time insured persons, after paying the basic medical insurance premiums in full according to the individual payment standards of the year, enjoy the basic medical insurance benefits from the month of payment.

Those who have interrupted payment for more than one year to renew their insurance will be calculated from the day when the basic medical insurance premiums for the year are paid in full, and they will begin to enjoy the newly-occurring basic medical insurance benefits after 2 months.

Newborns who participate in insurance and pay premiums within 3 months after birth will enjoy basic medical insurance benefits from the time they are born.

 Outpatient treatment

Special chronic diseases will be paid 60% by the overall fund

What are the basic medical insurance benefits? It is understood that the basic medical insurance benefits include outpatient medical treatment, hospitalization medical treatment, childbirth medical treatment and student accidental injury medical treatment.

In terms of outpatient medical treatment, the medical expenses incurred by the insured persons in the outpatient clinics of designated community health service institutions or primary medical institutions shall be paid 55% by the outpatient overall fund and 45% by individuals.

For school students participating in the basic medical insurance for urban residents, the medical expenses incurred in school hospitals (including health clinics and infirmaries) that have a medical institution practice license and signed a fixed-point agreement with the social insurance agency shall be paid by the individual.
The upper limit is not less than 10%, and the specific share ratio is determined by the school and hospital (including health clinics and infirmaries) based on the balance of the outpatient overall planning fund.

The maximum annual payment limit of the Outpatient Coordination Fund is 200 yuan per person, and the medical expenses above the annual maximum payment limit shall be paid by individuals.
The maximum payment limit will be adjusted in due course.

Special medical treatment for chronic diseases in outpatient clinics.
21 kinds of diseases, including coronary heart disease, are identified as special chronic diseases in outpatient clinics.
Participants who have been approved to enjoy medical treatment for special chronic diseases (including 2 or more diseases) in outpatient clinics incur medical expenses that meet the scope of payment for special chronic diseases in outpatient clinics at designated medical institutions.
60% of the medical expenses shall be paid by the overall fund and 40% by the individual; the overall fund The minimum payment standard is 30 yuan/person·month, which shall be deducted from the total payment in accordance with the overall fund.

The annual maximum payment limit of the overall planning fund is implemented for each disease type, and the medical expenses exceeding the annual maximum payment limit shall be paid by the individual.

 

Hospitalization

Bed fee 20 yuan/bed·day The minimum payment standard for the first hospitalization within the year is 200 yuan

The "Methods" stipulate that insured persons incurred in the designated medical institutions for hospitalization medical expenses that meet the scope of basic medical insurance payment, and the payment shall be shared according to the following methods.

The payment standard of the bed fee pooling fund is 20 yuan/bed·day.

In terms of the minimum payment standards for the overall planning fund, the first hospitalization within the year, the minimum payment standards for the individual pooling funds of the third, second, first-level and below designated medical institutions are 600 yuan, 400 yuan, and 200 yuan respectively; for the second and above hospitalizations, individuals The minimum payment standards for the overall planning fund each time are 300 yuan, 200 yuan, and 100 yuan, which will be deducted from the total payment that meets the overall planning fund.

During the year of participating in the basic medical insurance, the maximum payment limit of the overall fund is 6 times the per capita disposable income of urban residents in Guangxi in the last year announced by the statistics department.